Francisco de la Peña

Construct validity and parent–child agreement of the six new or modified disorders included in the Spanish version of the kiddie Schedule for Affective Disorders and Schizophrenia present and Lifetime Version DSM-5 (K-SADS-PL-5)

Changes to the Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5) incorporate the inclusion or modification of six disorders: Autism Spectrum Disorder, Social Anxiety Disorder, Intermittent Explosive Disorder, Disruptive Mood Dysregulation Disorder, Avoidant/Restrictive Food Intake Disorder and Binge Eating Disorder. The objectives of this study were to assess the construct validity and parent-child agreement of these six disorders in the Spanish language Schedule for Affective Disorders and Schizophrenia for School Age Children Present and Lifetime Version (K-SADS-PL-5) in a clinical population of children and adolescents from Latin America. The Spanish version of the K-SADS-PL was modified to integrate changes made to the DSM-5. Clinicians received training in the K-SADS-PL-5 and 90% agreement between raters was obtained. A total of 80 patients were recruited in four different countries in Latin America. All items from each of the six disorders were included in a factor analysis. Parent-child agreement was calculated for every item of the six disorders, including the effect of sex and age. The factor analysis revealed 6 factors separately grouping the items defining each of the new or modified disorders, with Eigenvalues greater than 2. Very good parent-child agreements (r>0.8) were found for the large majority of the items (93%), even when considering the sex or age of the patient. This independent grouping of disorders suggests that the manner in which the disorders were included into the K-SADS-PL-5 reflects robustly the DSM-5 constructs and displayed a significant inter-informant reliability. These findings support the use of K-SADS-PL-5 as a clinical and research tool to evaluate these new or modified diagnoses.

Adversidad psicosocial, psicopatología y funcionamiento en hermanos adolescentes en alto riesgo (HAR) con y sin trastorno por déficit de atención con hiperactividad (TDAH)

Introduccion. El trastorno por deficit de atencion con hiperactividad (TDAH) es un trastorno del neurodesarrollo altamente heredable. La determinacion de las caracteristicas clinicas, los factores de adversidad y el nivel de funcionamiento en hermanos de probandos con TDAH, denominados en alto riesgo (HAR), podria ayudar a establecer el riesgo al cual estan sometidos. Objetivo. Determinar la frecuencia de TDAH y otros trastornos psiquiatricos en HAR. Como objetivos secundarios, establecer los factores de adversidad psicosocial que predicen el TDAH en HAR y determinar la magnitud del efecto sobre el funcionamiento y otros trastornos psiquiatricos cuando los hermanos tienen TDAH (HAR TDAH +) comparados con quienes no lo tienen (HAR TDAH -). Material y metodo. Este estudio multicentrico es descriptivo, transversal y analitico. La muestra (n=84) se conformo por hermanos adolescentes de probandos diagnosticados con TDAH que compartian a ambos padres. Resultados. El 45.2% (n=38) tuvo TDAH. El 17.9% (n=15) no presento trastorno psiquiatrico alguno. Ser HAR TDAH+ incremento al menos cuatro veces mas la probabilidad de presentar trastorno negativista desafiante (RM=4.3; IC 95% 1.3-14.8), dato que mantuvo significancia al ajustarse por sexo, edad y numero de adversidades (RM=3 IC 95% 1.8–10.9). Ser HAR TDAH+ incremento casi cinco veces la probabilidad de presentar disfuncion academica (RM=4.84 IC 95% 1.41-16.63). El promedio general de adversidades fue 3.3 (DE=1.4). Encontramos psicopatologia en ambos padres en el 51.2% de la muestra (ES=0.055). La disfuncion familiar grave incremento 2.5 veces la probabilidad de presentar TDAH en los HAR (IC 95% 1.06–6.25). Al comparar los grupos con tres o mas adversidades psicosociales, no existieron diferencias significativas (81.6% vs. 65.2%; p=0.14). Conclusiones. El estudio clinico de los HAR para TDAH es necesario debido a las distintas implicaciones que tiene a nivel de la prevencion, la atencion oportuna y la mejoria del pronostico de estos sujetos

Validity and reliability of the kiddie schedule for affective disorders and schizophrenia present and lifetime version DSM-5 (K-SADS-PL-5) Spanish version

BackgroundThere are various language adaptations of the Schedule for Affective Disorders and Schizophrenia for School Age Children Present and Lifetime Version (K-SADS-PL). In order to comply with the changes in DSM classification, the Spanish edition of the interview was in need of update and evaluation.MethodsK-SADS-PL was adapted to correspond to DSM-5 categories. All clinicians received training, and a 90% agreement was reached. Patients and their parents or guardians were interviewed and videotaped, and the videos were exchanged between raters. Factor analysis was performed and inter-rater reliability was calculated only in the case of diagnoses in which there were more than five patients.ResultsA total of 74 subjects were included. The Factor Analysis yielded six factors (Depressive, Stress Hyperarousal, Disruptive Behavioral, Irritable Explosive, Obsessive Repetitive and Encopresis), representing 72% of the variance. Kappa values for inter-rater agreement were larger than 0.7 for over half of the disorders.ConclusionsThe factor structure of diagnoses, made with the instrument was found to correspond to the DSM-5 disorder organization. The instrument showed good construct validity and inter-rater reliability, which makes it a useful tool for clinical research studies in children and adolescents.